King Saud University

College of Nursing

NEEDLE
CRICOTHYROIDOTOMY

Hatem Alsrour
 DEFINITION
• Needle Cricothyroidotomy - the introduction
of an over-the-needle catheter device into
the cricothyroid membrane to provide a
temporary airway and oxygenation
 OBJECTIVES
At the completion of this lecture the participant will be able to:

• State the indications for needle

cricothyroidotomy

• Identify the equipment necessary to

perform needle cricothyroidotomy

• Identify the landmarks of the

cricothyroid membrane
-Discuss the potential complications of needle
cricothyroidotomy

-Successfully perform needle cricothyroidotomy on a

manikin
 INDICATIONS

• Unconscious patient with a complete

airway obstruction unrelieved by all
other means appropriate to the situation

• BASE STATION ORDER

 CAUSES OF AIRWAY
OBSTRUCTION
– foreign body aspiration
– severe facial trauma
– infections
– swelling of the airway
– external swelling from injury
 CONTRAINDICATIONS
• Patient weighing less than 40 kg

• Unable to identify landmarks

 CRICOTHYROID
MEMBRANE
• Is located between
the thyroid and
cricoid cartilage on
the anterior neck

Cricothyroid
Membrane
 SURROUNDING
STRUCTURES
• Thyroid cartilage

• Thyroid gland

• Parathyroid glands
LANDMARKS
Locate the superior
aspect of the thyroid
cartilage (prominence
on the anterior neck)

Follow down midline

to the indentation of the
cricothyroid membrane
• The carotid arteries
and jugular veins

• Additional blood
vessels that feed
into the thyroid
gland
 COMPLICATIONS
• Penetration of adjacent structures
(esophagus)
• Subcutaneous emphysema
• Swelling
• Severe bleeding
• Damage to the larynx
• Injury to the thyroid and parathyroid
glands
 EQUIPMENT
• Personal protective equipment
• Emergency Transtracheal Airway
Catheter
• ENK Flow Modulator
• 10 cc syringe
• Alcohol prep
• 02 tank capable of delivering 30-60 psi
• Cloth or silk tape
 EQUIPMENT (con’t)
• Emergency
Transtracheal
Airway Catheter
– The ribbing on the
catheter keeps it
from collapsing or
kinking
• ENK Flow
Modulator
and pressure
adapter
• Connect to 15 L of 02 (1)
• Covering and
uncovering the holes (3)
allows for oxygen
movement in and out of (2)
the lungs (2)

• Medication can be
administered through (1)
the port into the trachea
(3)
• The needle and modulator will come
prepackaged

• Needle cricothyrotomy is recommended

when unable
• to oxygenate/ventilate children < 12 years
of age
 PROCEDURE
• Once your equipment is assembled,
position the patient’s head

• If trauma - maintain the head in neutral

position
• If no trauma-
extend the
neck
• Identify the
superior aspect
of the thyroid
cartilage
– prominence,
midline, anterior
neck
• Follow midline down to
the soft cricothyroid
membrane
(approximately 1 cm)
• Cleanse the
site with an
alcohol prep
• Stabilize the larynx
by holding the
cartilage between
your fingers

• Direct the needle at

a 90o angle to the
patient

• Slowly advance the

needle 1/2” - 3/4”
with plastic catheter
• Attempt to aspirate
free air as you
advance
• Once you have
aspirated free
air, direct the
needle toward
the sternal notch
• Remove the needle
• Attach the catheter
to the ENK Flow
Modulator

• DO NOT LET GO
OF THE
CATHETER
• Assess the patient’s ABCs
– do not expect to see significant rise and fall
of the chest wall

– if the patient begins spontaneous

breathing, time your oxygenation with
inhalation
– monitor patient’s color and heart rate

– if available, pulse oximeter may be helpful

– don’t forget COMPRESSIONS, if pulse is

absent